An environmental disinfection intervention to prevent C. difficile transmission

描述（由申请人提供）： 受污染的表面是艰难梭菌传播的重要潜在来源，一些改善环境清洁的干预措施与CDI的减少有关。然而，很少有干预措施包括监测，以确认孢子根除的效果，并有不确定性的最佳策略，环境消毒。该提案的目标是制定循证环境消毒策略，并测试其在降低医疗保健相关CDI率方面的有效性。我们的具体目标是：目标1。确定包括持续监测和反馈的干预措施是否会改善客房部员工的环境消毒。我们的工作假设是，一种干预措施，包括家政人员的积极参与和持续的监测和反馈（即，增强的清洁）将导致孢子根除的持续改进。我们将进行荧光标记方法的前后试验，以提供监测和反馈。主要结局指标是CDI房间消毒的有效性。医疗保健相关CDI的发生率将是次要结局指标。目标2.确定连续使用移动的自动UV-C辐射设备是否会进一步加强环境消毒。我们的工作假设是，与加强清洁相比，连续使用自动UV-C装置将进一步改善孢子根除和降低CDI发生率。为了实现这一目标，我们将使用交叉设计在克利夫兰退伍军人医疗中心的12个病房进行为期2年的随机试验。主要结局指标将是医疗保健相关CDI的发生率。目标3.确定加强清洁干预是否会降低多家VA医院的医疗保健相关CDI发生率。我们的工作假设是，一个增强的清洁干预，包括由家政人员的积极参与和持续的监测和反馈，使用荧光标记方法将降低率的医疗保健相关的CDI。为了实现这一目标，我们将对多家VA医院进行为期1年的随机试验，以比较标准清洁（即，仅通过观察监测清洁）与增强清洁（即，包括使用荧光标记方法的监测和反馈）。主要结局指标将是医疗保健相关CDI的发生率。.

DESCRIPTION (provided by applicant): Contaminated surfaces are an important potential source for transmission of Clostridium difficile, and some interventions to improve environmental cleaning have been associated with reductions in CDI. However, few interventions have included monitoring to confirm the efficacy of spore eradication and there is uncertainty regarding optimal strategies for environmental disinfection. The goal of this proposal is to develop evidence-based environmental disinfection strategies and test their effectiveness in reducing rates of healthcare-associated CDI. Our specific objectives are: Objective 1. Determine if an intervention that includes ongoing monitoring and feedback will improve environmental disinfection by housekeeping staff. Our working hypothesis is that an intervention including active participation by housekeeping staff and ongoing monitoring and feedback (i.e., enhanced cleaning) will result in sustained improvement in eradication of spores. We will perform a before and after trial of a fluorescent marker method to provide monitoring and feedback. The primary outcome measure will be effectiveness of CDI room disinfection. Incidence of healthcare-associated CDI will be a secondary outcome measure. Objective 2. Determine if adjunctive use of a mobile, automated UV-C radiation device will further enhance environmental disinfection. Our working hypothesis is that adjunctive use of an automated UV-C device will result in further improvement in eradication of spores and reduction of CDI incidence in comparison to enhanced cleaning. To accomplish this objective, we will perform a 2-year randomized trial of 12 wards at the Cleveland VA Medical Center using a cross-over design. The primary outcome measure will be incidence of healthcare-associated CDI. Objective 3. Determine if an enhanced cleaning intervention will reduce rates of healthcare-associated CDI in multiple VA hospitals. Our working hypothesis is that an enhanced cleaning intervention that includes active participation by housekeeping staff and ongoing monitoring and feedback using the fluorescent marker method will reduce rates of healthcare-associated CDI. To accomplish this objective, we will perform a 1-year randomized trial of multiple VA hospitals to compare standard cleaning (i.e., monitoring of cleaning through observation only) versus enhanced cleaning (i.e., including monitoring and feedback using the fluorescent marker method). The primary outcome measure will be incidence of healthcare-associated CDI. .